ATW - S1E18
Laura Banner

Laura Banner

Family Nurse Practitioner, Dementia Trainer & Advocate,
Keynote Speaker (Available for speaking engagements on Dementia)

Menopause, Memory and Dementia

Menopause and memory problems.

Well, I’m just going to take a wild guess and say any woman who’s either perimenopausal or menopausal is not surprised to hear those two terms in the same sentence, what we understand is that it is very common for women who are either perimenopausal or menopausal to experience memory difficulties, similar to the type of memory issues that women who are in the early stages of Alzheimer’s disease have. That would be the short term memory issue that you’re struggling with. Perhaps you’re having a little bit of word-finding difficulty, or even a little bit of just general recall problems.

It’s not surprising, because what we know is that estrogen, the primary hormone involved in perimenopause and menopause is decreased during those times, and with the sudden decrease in estrogen, memory struggles. Now, there’s a lot that we can talk about in terms of estrogen in memory, so let’s break it down a little further.

What we know is that memory, as it relates to estrogen, goes back to the most potent forms of estrogen. That’s the estradiol form. And what estradiol does is it actually helps with the creation of memory. So as your estrogen is increased in quantity. So are the receptors in the areas of the brain that are involved in memory, memory loss, or retention of memory. Specifically, I’m talking about the hippocampus and the prefrontal cortex, that’s in the front part of the brain. What we know about brain cells is that they have these extensions, and these extensions are kind of like tentacles if you will. And they’re called dendrites, and at the tips of the dendrites are the short segments called spines. And that’s actually the exact location where brain communication happens. So, as estrogen tends to decrease during perimenopause and menopause, the amount of receptors on the spine decreases, and as a result, we are less able to recall something, so that’s why we have some word-finding difficulty or some just general recall problems.

What we know is that both men and women have estrogen, and unlike men whose estrogen state is relatively stable throughout their life, women tend to decrease again during perimenopause and menopause. For those of you who are wondering what the difference is between perimenopause and menopause well, just a short explanation is perimenopause is when your cycle becomes irregular, you need to actually miss a cycle a menstrual cycle for 12 consecutive months before you’re considered to be in menopause. Prior to that, you are in this perimenopausal state, and you can linger in perimenopause for years; you can actually go 11 months without a cycle, have a cycle, and then you start all over again with 12 continuous months.

So, during perimenopause, as estrogen levels start to decline, your cycle becomes irregular, and you may have a little bit of memory issue. But as you are approaching the latter stage of perimenopause and entering menopause, you have a significant decline in your estrogen level.
And when people think of menopause, what they’re thinking about primarily both providers and the individual going through menopause, well hot flashes that probably tops the list, but also some mood swings, depression, and anxiety. But really what needs to happen, in my opinion, is the conversation about memory impairment needs to be at the forefront.

We need to feel comfortable talking to people about the fact that while they’re in menopause, that they will experience some memory difficulty and not to be alarmed, because often, not always, but often once they complete menopause, which also can last several years, unfortunately, memory starts to improve.

So let’s go back to estrogen. Now, once you are in menopause, a lot of people opt for hormone replacement therapy, the reason that they opt for hormone replacement therapy is that estrogen is the youth hormone if you will. Once your levels decline, a lot of things start to happen, that we don’t want to happen. For example, the youthful look that we have tends to disappear; sexual relations tend to be very uncomfortable, and, again, mood tends to be erratic. So, once someone is in menopause, a lot of people want to go back to the days when estrogen levels were normal. And the way that they do that is by taking estrogen, either through cream or through a tablet.

Now, let me talk a little bit about what estrogen does.
What we know is that as estrogen levels increase in concentration, then you are able to produce or synthesize if you will, more acetylcholine, which is a neurotransmitter or chemical that we make that is critical for memory formation. So, as estrogen levels decline, memory declines. Again, by taking hormone replacement therapy, you are increasing your estrogen level, and as a result, mood improves, and so does memory.

So, what we know is that memory loss is tied directly to the decrease of estrogen levels. Now, hormone replacement therapy is quite controversial. A lot of people think about it as increasing your risk of heart attack and stroke. And yes, that is true, but with everything in medicine, you measure the risks and benefits. So let’s talk about some of the risks and benefits with hormone replacement therapy, beyond heart attack and stroke.

What we know is that if you do take hormones, specifically estrogen, that it can increase your risk of developing Alzheimer’s disease. Somewhere between 15 and 38% is what I’ve read. And this is only when people start hormone replacement therapy after age 60.

So if you’re in your 40s or you’re in your 50s in during menopause, and you’re considering starting hormone replacement therapy, this would not apply to you. And of course, as always, this would be something you would need to discuss with your healthcare provider. Research has also shown that vaginal forms of estrogen replacement are not associated with increased risks of Alzheimer’s disease. So the bottom line is you always want to consider the risks and the benefits before you move forward with any type of therapy, including hormone replacement therapy.

There is a belief that estrogen, whether it’s natural or synthetic, meaning that we take it in the form of a pill or cream, may protect women against the formation of amyloid-beta proteins, which are the plaques that are known to cause Alzheimer’s disease. Now, the American College of Obstetricians and Gynecologists, also known as ACOG, does not recommend routine discontinuation of estrogen after someone is 60 or older. Again, it’s all about the risks and benefits of any type of therapy that you may start.

So what do you do if you’re not comfortable starting hormone replacement therapy, but you’re symptomatic for all the issues that ensue because of lack of estrogen. Let’s talk about hot flashes, for example, what do you do? Well, there is a thought. In fact, there’s been a few studies that say that then the vaccine, also known as EFFEXOR, which by category is an antidepressant, does tend to help hot flashes when given at 75 milligrams, which is a very low dose of that drug. But some people just don’t want to be on an antidepressant if they don’t need it. So, what else can you do? Another option is to consider Phytoestrogens, also known as dietary estrogens, these are naturally occurring plants that are rich in a form of estrogen. A little bit controversial. So, some Phytoestrogens are believed to cause some negative impact, and some are believed to promote some positive benefits of estrogen. And it’s not as clear as a divided line, these phytoestrogens are beneficial, and these phytoestrogens are harmful. Each has some data that shows benefits and possible negative outcomes.

It’s very limited in terms of the available studies at this point. So again, you need to use your best judgment. So what are some of the different foods that are rich in phytoestrogens? Well, flaxseed soybeans and edamame is are definitely rich in it. Dried fruits are as well, sesame seeds and garlic, peaches and berries, wheat bran, and even tofu. And then some other vegetables, the cruciferous vegetables, the cauliflowers, the broccolis, the Brussels sprouts. Everything in moderation, and again, you have to use your best judgment. If you decide to go ahead and pursue the phytoestrogens as a form of natural estrogen replacement, and you’re trying to decide whether or not it’s working. I think a 90-day trial would certainly be sufficient for you to determine whether or not it’s helping.

Just remember this, that perimenopause and menopause do bring on memory issues. If you have a family history of Alzheimer’s or some other type of dementia, and you find yourself struggling, especially for short term memory issues. Do not let that raise your anxiety that, in fact, maybe you’re developing Alzheimer’s. Hopefully, it will be temporary.

There are things you can do, first and foremost, don’t stress. I know that’s easier said than done. But it’s important. Remember, it is not an indication that you are headed down the road of developing Alzheimer’s. That said, it is important to remember that two-thirds of all individuals with Alzheimer’s are women, so it’s hard not to ignore that estrogen does play a role in memory impairment, What you can do, you can also increase your physical activity. There are so many benefits to doing that, not only are you adding something healthy to your daily routine, you’re improving your blood flow which is good for the brain, but you also will have a release of natural endorphins, and that will improve your mood and exercise on a regular basis, also helps with sleep, and we know that when you’re perimenopausal or menopausal, your sleep pattern is disrupted, that’s a very gentle way of saying it.

Consider some dietary changes beyond consideration of the phytoestrogens. Make sure that you’re eating well, having well-balanced meals, avoid excessive sugar intake. Limit your amount of alcohol. There is a lot of correlation between excessive alcohol intake and multiple medical conditions; for a woman, they recommend no more than four alcoholic beverages per week. They do not further define that as beer and wine versus hard alcohol. Again, the recommendation is no more than four alcoholic beverages per week. You want to continue to stimulate your brain, that’s very important that neuroplasticity that I’ve talked about on previous podcasts. So what do you do to stimulate your brain?

Well, you need to change something up in your routine. If you’re already multitasking and you’re up at dawn, and you work all day long, and you are working hard, fulfilling your career, or doing things around the home, unfortunately, that’s not enough. You need to do something new, something stimulating something that is forcing your brain to be positively stressed. Suppose you haven’t already checked it out. I do something called Mind Challenge every Monday; I release it on my Instagram account, through video. But then I also post it on my website under the My mind challenge tab, and all the questions are written there. So you can do this week’s questions, and you can do all the previous week’s questions that will get you thinking.

You can also go ahead and check out on the Products page of compassionate education under the shop tab, the chatbox, the chatbox is a clever little box that just has some thought-provoking questions. It’s fun to do with family members or friends you can make a game out of it. Have some people over, and it’s kind of like Trivial Pursuit, except it’s your life, your experiences, your thoughts and opinions. Also very very helpful for anyone who is experiencing age-related memory impairment. Believe it or not, coloring books, you might be laughing thinking, what is she talking about, but adult coloring books are great in terms of a calming effect. It’s also very good for hand-eye coordination and creativity. So that’s something you can do. You need to get involved. Get involved in life be social. Don’t come home at the end of the day, sit on the couch, and fall asleep to some TV program that is not positively stressing your brain.

You need to go ahead and share your thoughts and feelings with friends. Going through perimenopause or menopause is very stressful, and what can help is to know that what you’re experiencing is completely normal. So if you’re not already talking about it with someone who understands, someone who was in it themselves, or has already gone through it.
I absolutely recommend that you have someone that you can talk to. Because just knowing that what you’re experiencing is normal, that alone can be very therapeutic.

Anyway, rest assured, once perimenopause and menopause are behind you, your short term memory will improve. It’s a transient period of time, but it is very stress-provoking. So yes, menopause and memory are interrelated, but it is not necessarily an indication of what your future may look like. So take control. Go ahead. Stretch your brain in a positive way and do all the things that we’ve talked about that you need to do to have a healthy lifestyle.

Anyway, I hope you find this helpful, please feel free to check out my Instagram account and my website. Thanks so much, I appreciate you listening. Please feel free to subscribe. I release new episodes every Tuesday. Thanks again. Bye-bye. 

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